UK’s cross-border divide in cancer drug access "is growing"

Cancer patients in Wales and Northern Ireland are increasingly being denied access to drug treatments which are available to patients in England and Scotland, a leading charity claims.

During October 2009-December 2010, 35 patients in Wales were denied life-extending cancer treatments and more than 100 others had to apply under "exceptional case" procedures in a final attempt to secure access to treatments recommended by their doctors, according to a new report from the Rarer Cancers Foundation (RCF).

Moreover, 22 drugs for which doctors in England can now apply to access through the new Cancer Drugs Fund are not available to patients in Wales, while doctors there are six times less likely to make an "exceptional case" application than they are in Scotland, and the approval rate for such applications in Wales is only 67% compared to 87% in Scotland, it says.

"Patients who are unable to secure NHS funding for their treatment are thus forced to go without potentially life-saving treatments - or pay 'top-ups' themselves of nearly £21,000 each," says the Foundation.

The charity is also concerned about access issues in Northern Ireland, and has warned the country's First Minister that patients there are now "having to climb three separate mountains" to gain access to the cancer treatments they need.

The first "mountain" is delays in availability of drugs approved by the National Institute for Health and Clinical Excellence (NICE). Routine access to seven NICE-approved drugs is being blocked in Northern Ireland, with delays currently averaging more than six months and expected to lengthen as a result of the funding cuts, says the RCF.

Also, with no equivalent of England's Cancer Drugs Fund, Northern Ireland has no clear mechanism through which to access treatments that are not recommended by NICE on the grounds of cost-effectiveness. As a result, there are now 19 treatments for which patients will be denied access, it adds.

Finally, there is a danger that Individual Funding Requests - "the last resort" for patients who need life-extending treatments - may not be funded in the future, says the Foundation. The draft budget of Northern Ireland's Department of Health and Social Services and Public Safety has warned that a consequence of real-terms cuts in health spending may be "no new patients on high-cost drugs," it notes, and points out that budget cuts have already led to the cancellation of a promised radiotherapy centre in Londonderry.

RCF chief executive Andrew Wilson said the Foundation's analysis of the situation in Wales provides the proof that patients there are being denied treatments which they would get elsewhere in the UK. "The political parties must look at the evidence and act now to fix this broken and unfair system," he said.

He added that the position in Northern Ireland is unacceptable and cannot be justified on the basis of either clinical need or the relative funding settlement to the administration there compared to others in the UK. The RCF believes the treatments are affordable, he said: "our analysis shows that providing additional funding to the equivalent level of the Cancer Drugs Fund would cost just £5.8 million per annum, benefitting an estimated 279 patients," and he has written to the First Minister "urging him to do everything he can to address this extremely worrying situation."